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Predictors of Positive Retroperitoneal Lymph Nodes in Patients with High Risk Testicular Cancer
Ravi Kacker, Stephen Williams, Graeme S Steele, Jerome P Richie
Brigham and Women's Hospital, Boston, MA

Introduction: Percent of embryonal carcinoma and lymphovascular invasion (LVI) in the primary tumor are risk factors for occult retroperitoneal metastatic disease. High risk patients with clinical stage I and IIA non-seminomatous germ cell tumor who underwent primary retroperitoneal lymph node dissection (P-RPLND) were identified to discern any other risk factors for metastatic disease.
Materials & Methods: Patients who had undergone RPLND at our institution from 1993 to 2009 were identified and clinical charts reviewed. Ninety patients with orchiectomy specimens containing greater than 30% embryonal carcinoma who underwent P-RPLND were identified and peri-operative data was obtained.
Results: 90/353 (25%) patients had greater than 30% embryonal carcinoma and underwent P-RPLND. Of these, 45 (50%) had combined LVI. Median follow-up time was 1.1 years. Positive lymph nodes identified at RPLND were noted in 30 (46%) and 15 (60%) of patients with CSI vs. CSII disease. On multivariate analysis, embryonal carcinoma (OR 1.02, 95%CI 1.00-1.04) and LVI (OR 3.52, 95%CI 1.43-8.67) were associated with positive lymph nodes at RPLND. The positive predictive value for 100% embryonal carinoma was 65.5% although the negative predictive value for 30% embryonal carinoma was 85.7%.
Conclusions:
Embryonal carcinoma and LVI were significantly and independently associated with risk for occult retroperitoneal metastatic disease. These Results should be taken into consideration when counseling patients about appropriate treatment options.


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